Requiring Pacemaker Within 30 Days of TAVR Linked To Worse Prognosis

MedicalResearch.com Interview with:
Opeyemi O. Fadahunsi, MBBS, MPH
Department of Medicine
Reading Health System
West Reading, Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to managing symptomatic severe aortic stenosis in patients who have a high surgical risk or are deemed to be inoperable. One of the most frequent complications is development of conduction abnormalities requiring permanent pacemaker placement. We compared clinical outcomes in patients requiring permanent pacemaker placement post-TAVR to those not requiring a pacemaker using a large US database called the STS/ACC TVT RegistryTM . We used real-world data of patients undergoing TAVR in the US at 229 sites between November 2011 and September 2014.

The frequency of pacemaker placement within 30 days post-TAVR was 6.7% (651 of 9,785 patients). Those who needed a pacemaker within 30 days post-TAVR had longer hospital and intensive care unit stays compared to those who did not. Furthermore, those who needed a pacemaker had a higher risk of death from any cause at one year compared to those who did not get a pacemaker.

MedicalResearch.com: What should readers take away from your report?

Response: Pacemakers definitely do save lives, however, for reasons yet to be understood, this study showed a higher risk of death in patients who required a pacemaker within 30 days of TAVR.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Efforts should be directed toward those at highest risk of developing significant conduction abnormalities post-TAVR to see what refinements in device and technique could ameliorate the risk described in this study. Also, more studies are needed to better understand why patients who need pacemakers in the setting of recent TAVR have worsened outcomes.

MedicalResearch.com: Is there anything else you would like to add?

Response: TAVR represents a great advance in medical care and offers a therapeutic
option for patients with symptomatic severe aortic stenosis who are deemed
inoperable or have a high surgical risk, but more research is needed to
better understand why patients needing permanent pacemakers have
worsened outcomes to help guide further refinements of device and
placement techniques.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. J Am Coll Cardiol Intv.2016;9(21):2189-2199. doi:10.1016/j.jcin.2016.07.026.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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